STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE COUNTY OF MECKLENBURG DI STRICT COURT DIVISION FILE NO.: IN THE MATTER OF: _______________________ ) _______________________ ) ) REFERRAL ORDER TO V. ) PROPOSED PARENT _______________________ ) COORDINATOR ______________________ _ ) ) The Court proposes appointing ______________ as the Parent Coordinator in the above captioned case and requests that the proposed Parent Coordinator respond in writing by _________ to the undersigned judge with copies to the attorneys as to his or her acceptance of the proposed appointment. The major components of the existing custody and visitation arrangement are as follows: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _________________________________________________ The parties and guardian ad litem identify the issues to be addressed by the Parent Coordinator as follows: Plaintiff : ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _______________________________________________________________ Defendant: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _______________________________________________________________ Guardian ad litem: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _______________________________________________________________ This ________ day of __________, 20____. ________________________ CCF-48 District Court Judge Presiding